Role of therapeutic plasma exchange in the complex treatment of severe kidney diseases

Abstract

PURPOSE: The strongest effect of therapeutic plasma exchange (TPE) is achieved in diseases with immune and autoimmune genesis, hyperviscous conditions and intoxications of various origins. The aims of the study were to assess the long-term effect of TPE in the complex therapy of severe renal diseases and to highlight therapeutic strategies necessary to achieve good clinical results. MATERIAL AND METHODS: During the period 1980-2010, TPE was carried out in the form of a complex treatment of 87 patients with immune nephropathies and 44 patients with malignant myeloma. The primary diseases were the following: chronic glomerulonephritis - 42, lupus nephropathy - 31, Henoch-Schonlein nephritis - 8, Wegener granulomatosis ± four and Goodpasture syndrome - two patients. The diagnosis was confirmed after a puncture kidney biopsy in 72 (82.8%) patients with immune nephropathies. TPE was performed using centrifugal or filtration methods. RESULTS: The patients with immune nephropathies underwent between 5 and 7 consecutive plasma exchanges daily or every two days. A three consecutive days of corticosteroid pulse therapy was initiated after last procedure followed by conventional immunosuppressive therapy. After serial TPE a significant decrease in anti-GMB antibodies and circulating immune complexes was detected. Continuous clinical and paraclinical remission was achieved in 62.7% of the patients who received the combined treatment. CONCLUSION: TPE has a beneficial effect after being included in the complex treatment of patients with severe immune nephropathies. The immunomodulation contributes to the successful management of severe ongoing autoimmune processes. In patients with hyperviscosity, “supporting” TPE every 2 or 3 months is required to lower the increased viscosity, to prevent thromboembolic complications, and to slow-down nephropathy progression. Scripta Scientifica Medica 2013; 45(1): 66-70.